Individual
LEONARD J BODNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
579A CRANBURY RD, UNIVERSITY RADIOLOGY GROUP PC, EAST BRUNSWICK, NJ 08816-5426
(732) 390-0040
(732) 390-1856
Mailing address
579A CRANBURY RD, UNIVERSITY RADIOLOGY GROUP PC, EAST BRUNSWICK, NJ 08816-5426
(732) 390-0040
(732) 390-1856
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
25MA04617100
NJ
2085R0204X
Vascular & Interventional Radiology Physician
Primary
25MA04617100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00610004
—
NY
05
—
5109400
—
NJ
Enumeration date
11/15/2005
Last updated
01/03/2011
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